Academic Vascular Surgical Unit, Hull York Medical School, Hull, United Kingdom.
Department of Allied Health Professionals, Sheffield Hallam University, Sheffield, United Kingdom.
J Vasc Surg. 2021 Dec;74(6):2076-2085.e20. doi: 10.1016/j.jvs.2021.03.063. Epub 2021 Jun 2.
Supervised exercise programs (SEP) are effective for improving walking distance in patients with intermittent claudication (IC) but provision and uptake rates are suboptimal. Access to such programs has also been halted by the Coronavirus pandemic. The aim of this review is to provide a comprehensive overview of the evidence for home-based exercise programs (HEP).
This review was conducted in according with the published protocol and PRISMA guidance. Medline, EMBASE, CINAHL, PEDro, and Cochrane CENTRAL were searched for terms relating to HEP and IC. Randomized and nonrandomized trials that compared HEP with SEP, basic exercise advice, or no exercise controls for IC were included. A narrative synthesis was provided for all studies and meta-analyses conducted using data from randomized trials. The primary outcome was maximal walking distance. Subgroup analyses were performed to consider the effect of monitoring. Risk of bias was assessed using the Cochrane tool and quality of evidence via GRADE.
We included 23 studies with 1907 participants. Considering the narrative review, HEPs were inferior to SEPs which was reflected in the meta-analysis (mean distance [MD], 139 m; 95% confidence interval [CI], 45-232 m; P = .004; very low quality of evidence). Monitoring was an important component, because HEPs adopting this strategy were equivalent to SEPs (MD, 8 m; 95% CI, -81 to 97; P = .86; moderate quality of evidence). For HEPs vs basic exercise advice, narrative review suggested HEPs can be superior, although not always significantly so. For HEPs vs no exercise controls, narrative review and meta-analysis suggested HEPs were potentially superior (MD, 136 m; 95% CI, -2 to 273 m; P = .05; very low quality of evidence). Monitoring was also a key element in these comparisons. Other elements such as appropriate frequency (≥3× a week), intensity (to moderate-maximum pain), duration (20 progressing to 60 minutes) and type (walking) of exercise were important, as was education, self-regulation, goal setting, feedback, and action planning.
When SEPs are unavailable, HEPs are recommended. However, to elicit maximum benefit they should be structured, incorporating all elements of our evidence-based recommendations.
监督下的运动方案（SEP）对于改善间歇性跛行（IC）患者的步行距离是有效的，但提供和接受率不理想。由于冠状病毒大流行，此类方案的实施也已停止。本综述的目的是提供一个全面的综述，介绍家庭运动方案（HEP）的证据。
本综述是根据已发表的方案和 PRISMA 指南进行的。检索了 Medline、EMBASE、CINAHL、PEDro 和 Cochrane CENTRAL 中与 HEP 和 IC 相关的术语。纳入了将 HEP 与 SEP、基本运动建议或 IC 无运动对照进行比较的随机和非随机试验。对所有研究进行叙述性综述，并对随机试验数据进行荟萃分析。主要结局是最大步行距离。进行了亚组分析以考虑监测的影响。使用 Cochrane 工具评估偏倚风险，并通过 GRADE 评估证据质量。
我们纳入了 23 项研究，共 1907 名参与者。考虑到叙述性综述，HEP 不如 SEP，这在荟萃分析中得到了反映（平均距离[MD]，139 m；95%置信区间[CI]，45-232 m；P =.004；极低质量证据）。监测是一个重要的组成部分，因为采用这种策略的 HEP 与 SEP 相当（MD，8 m；95%CI，-81 至 97；P =.86；中等质量证据）。对于 HEP 与基本运动建议，叙述性综述表明 HEP 可能更好，但并非总是如此。对于 HEP 与无运动对照，叙述性综述和荟萃分析表明 HEP 可能更好（MD，136 m；95%CI，-2 至 273 m；P =.05；极低质量证据）。监测在这些比较中也是一个关键因素。其他要素，如适当的频率（≥3×每周）、强度（中度至最大疼痛）、时长（20 分钟逐渐增加到 60 分钟）和类型（步行）的运动，以及教育、自我调节、目标设定、反馈和行动计划都很重要。
当 SEP 不可用时，建议使用 HEP。但是，为了获得最大的益处，它们应该是结构化的，包含我们基于证据的建议的所有要素。
